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NPI Code Detail

MEDICARE: JOSE LUIS GODINEZ JR. PT, DPT

MEDICARE: JOSE LUIS GODINEZ JR. PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070.023176IL

General Provider Information

NPI Number : 1386161636
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE LUIS GODINEZ JR. PT, DPT
Provider Business Mailing Address
First Line : PO BOX 713260
Second Line :
City : CHICAGO
State : IL
Zip : 60677-1260
Country : US
Telephone Number : 630-469-9200
Fax Number :
Provider Business Practice Location Address
First Line : 536 S YORK ST
Second Line :
City : ELMHURST
State : IL
Zip : 60126-3952
Country : US
Telephone Number : 630-967-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2017
Last Update Date : 05/26/2023

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